Payment Integrity Analyst

Job Summary

To ensure the accuracy and compliance of healthcare claim payments, the full-time Payment Integrity Analyst will lead complex claim audits, develop claims editing rules, and monitor regulatory updates while collaborating with cross-functional teams in a remote environment.

Key responsibilities

• Lead complex claim audits and investigations involving high-risk or high-value claims
• Design, develop, and maintain advanced claims editing rules and logic
• Monitor CMS, OIG, and regulatory updates to ensure organizational compliance

Required qualifications

• Associate's or Bachelor's degree in Health Administration, Public Health, Business, or a related field (or equivalent experience)
• 5+ years of experience in healthcare claims, payment integrity, auditing, or revenue cycle
• Advanced expertise in coding systems, reimbursement methodologies, and CMS regulations
• Strong experience with claims editing platforms (e.g., Optum CES) and advanced SQL skills
• One or more relevant certifications (e.g., CPC, CCS, RHIT, RHIA)